Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (92 page)
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(koe-less-tir′a-meen)
Prevalite, Questran, Questran Light
Func. class.:
Antilipemic
Chem. class.:
Bile acid sequestrant
Do not confuse:
Questran
/Quarzan
Adsorbs, combines with bile acids to form insoluble complex that is excreted through feces; loss of bile acids lowers LDL, cholesterol levels
Primary hypercholesterolemia (esp. type IIa/IIb hyperlipoproteinemia), pruritus associated with biliary obstruction
Unlabeled uses:
Diarrhea caused by excess bile acid
Hypersensitivity; complete biliary obstruction; hyperlipidemia III, IV, V
Precautions:
Pregnancy (C), breastfeeding, children, PKU
Calculator
• Adult:
PO
4 g/day or bid, max 24 g/day
• Child:
PO
240 mg/kg/day in 3 divided doses with food or drink, max 8 g/day titrated up over several weeks to decrease GI effects
Available forms:
Powder for susp 4 g cholestyramine/packet or scoop; tab 1 g
•
Product daily or bid; give all other medications 1 hr before or 4-6 hr after cholestyramine to avoid poor absorption
•
Product mixed with applesauce or stirred into beverage (2-6 oz), let stand for 2 min; do not take dry, avoid inhaling powder, avoid GI tube administration, take with food
•
Supplemental doses of vit A, D, K if levels are low
•
Doses are expressed in anhydrous cholestyramine resin, amount of resin varies with each product
CNS:
Headache, dizziness, drowsiness, vertigo, tinnitus, anxiety
GI:
Constipation, abdominal pain, nausea
, fecal impaction, hemorrhoids, flatulence, vomiting, steatorrhea, peptic ulcer
HEMA:
Bleeding,
increased PT
INTEG:
Rash, irritation of perianal area, tongue, skin
META:
Decreased vit A, D, K, red cell folate content;
hyperchloremic acidosis
MS:
Muscle, joint pain
PO:
Excreted in feces, LDL lowered within 4-7 days, serum cholesterol lowered within 1 mo, duration 2-4 wk
Decrease:
absorption of warfarin; thiazides; cardiac glycosides; propranolol; corticosteroids; iron; thyroid hormones; acetaminophen; amiodarone; penicillin G; tetracyclines; clofibrate; gemfibrozil; oral vancomycin, glipiZIDE; vit A, D, E, K
Increase:
AST, ALT, alk phos
Decrease:
sodium, potassium
•
Cardiac glycoside level if both products administered, may need to adjust dose of cardiac glycoside, if this product is increased or decreased
•
For signs of vit A, D, K deficiency
•
Hypercholesterolemia:
fasting LDL, HDL, total cholesterol, triglyceride levels, electrolytes if receiving extended therapy; diet history
•
Pruritus:
for signs of itching
•
Bowel pattern daily; increase bulk, water in diet for constipation; diarrhea may also occur
•
Therapeutic response: decreased LDL, cholesterol level (hyperlipidemia); diarrhea, pruritus (excess bile acids)
About the symptoms of hypoprothrombinemia: bleeding mucous membranes, dark tarry stools, hematuria, petechiae; report immediately
•
To take with food, never use dry
•
That PKU patients should avoid Questran Light (contains aspartame and phenylalanine)
•
About the importance of compliance
•
That risk factors should be decreased: high-fat diet, smoking, alcohol consumption, absence of exercise
•
That GI side effects will resolve with continued use
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(si-doh-foh′veer)
Vistide
Func. class.:
Antiviral
Chem. class.:
Nucleotide analog
Suppresses cytomegalovirus (CMV) replication by selective inhibition of viral DNA synthesis
CMV retinitis in patients with HIV; used with probenecid
Unlabeled uses:
Adenovirus, condylomata acuminata, eczema vaccination, Epstein-Barr virus, generalized vaccinia, herpes genitalis/simplex, HPV, molluscum contagiosum, vaccinia necrosum, vaccinia, varicella-zoster, variola
Hypersensitivity to this product, probenecid, sulfa products; direct intraocular injection
Black Box Warning:
Proteinuria, renal disease/failure
Precautions:
Pregnancy (C), breastfeeding, children <6 mo, geriatric patients, preexisting cytopenias, renal function impairment, platelet count <25,000/mm
3
Black Box Warning:
Neutropenia, infertility, secondary malignancy
Calculator
• Adult:
IV
5 mg/kg q wk × 2 wk then 3 mg/kg q2wk, give with probenecid
• Adult:
IV
CCr <55 ml/min, do not use; SCr increase of 0.3-0.4 mg/dl above baseline, decrease dose to 3 mg/kg; SCr increase of ≥0.5 mg/dl above baseline or ≥21 proteinuria, discontinue
Available forms:
Inj 75 mg/ml
Administer:
Black Box Warning:
Use cytotoxic handling procedures
•
Allow to warm to room temperature
•
If product comes in contact with skin, wash with soap and water immediately
•
If zidovudine is used, reduce dose to 50% on cidofovir treatment days
•
Dilute
in 100 ml 0.9% saline sol before administration; probenecid must be given PO 2 g 3 hr before the cidofovir inf and 1 g at 2 and 8 hr after ending the cidofovir inf;
give
1 L of 0.9% saline sol IV with each INF of cidofovir, give saline INF over 1-2 hr period immediately before cidofovir; patient should be given a 2nd L if the patient can tolerate the fluid load (2nd L given at time of cidofovir or immediately afterward, should be given over 1-3 hr)
•
Give
slowly; do not give by bolus IV, SUBCUT inj
•
Use diluted sol within 24 hr, do not freeze; do not use sol with particulate matter or discoloration
•
Do not admix
CNS:
Fever, chills
,
coma,
confusion, abnormal thoughts,
dizziness
, bizarre dreams,
headache
, psychosis, tremors, somnolence, paresthesia,
amnesia, anxiety, insomnia
,
seizures
CV:
Dysrhythmias, hypo/hypertension
EENT:
Retinal detachment with CMV retinitis
GI:
Abnormal LFTs,
nausea, vomiting, anorexia, diarrhea
, abdominal pain,
hemorrhage
GU:
Hematuria,
increased creatinine, BUN,
nephrotoxicity
HEMA:
Granulocytopenia, thrombocytopenia, irreversible neutropenia, anemia, eosinophilia
INTEG:
Rash, alopecia, pruritus
,
acne
, urticaria, pain at inj site, phlebitis
RESP:
Dyspnea
Terminal half-life 2.6 hr
Black Box Warning:
Nephrotoxicity:
amphotericin B, foscarnet, aminoglycosides, pentamidine IV, NSAIDs, salicylates; wait 7 days after use to begin cidofovir
•
Culture before treatment is initiated; cultures of blood, urine, and throat may all be taken; CMV not confirmed by this method; diagnosis made by ophthalmic exam
Black Box Warning:
Renal, hepatic, increased hemopoietic studies, BUN; serum creatinine, AST, ALT, creatinine, CCr, A-G ratio, baseline and drip treatment, blood counts should be done q2wk; watch for decreasing granulocytes, Hgb; if low, therapy may have to be discontinued and restarted after hematologic recovery; blood transfusions may be required, renal failure can occur also, Fancom syndrome
•
For GI symptoms: severe nausea, vomiting, diarrhea; severe symptoms may necessitate discontinuing product
•
Electrolytes and minerals: calcium, phosphorus, magnesium, sodium, potassium; watch closely for tetany during 1st administration
Black Box Warning:
Blood dyscrasias
(anemia, granulocytopenia); bruising, fatigue, bleeding, poor healing; leukopenia, neutropenia, thrombocytopenia: WBCs, platelets q2days during 2 ×/day dosing and every wk thereafter; check for leukopenias with daily WBC count in patients with prior leukopenia, with other nucleoside analogs, or for whom leukopenia counts are <1000 cells/mm
3
at start of treatment
•
Allergic reactions: flushing, rash, urticaria, pruritus
•
Monitor serum creatinine or CCr at least q2wk; give only to those with creatinine levels ≤1.5 mg/dl, CCr >55 ml/min, urine protein <100 mg/dl
•
Therapeutic response: decreased symptoms of CMV
•
To notify prescriber if sore throat, swollen lymph nodes, malaise, fever occur; may indicate other infections
•
To report perioral tingling, numbness in extremities, paresthesias; report rash immediately
•
That serious product interactions may occur if OTC products are ingested; check with prescriber
•
That product is not a cure but will control symptoms
•
That regular ophthalmic exams, renal studies must be continued
•
That major toxicities may necessitate discontinuing product
•
To use contraception during treatment; that infertility may occur; and that men should use barrier contraception for 90 days after treatment
Discontinue product; use hemodialysis, increase hydration